A Long-Term Perspective

The concept/phenomenon of valve prosthesis/patient mismatch (VP–PM), described in 1978, has stood the test of time. From that time to 2011, VP–PM has received a great deal of attention but studies have come to varying conclusions. This is largely because of the determination of prosthetic heart valve area [called effective orifice area index (EOAi)] by projection rather than by actual measurement, variable criteria to assess severity of EOAi and the timing of determination of EOAi. All prosthetic heart valves have some degree of VP–PM which must be placed in a proper clinical perspective. This can be done by determining its effects on function and outcomes. For mortality one needs to focus especially on severe/critical degree of VP–PM and determine the cause of death was due to VP–PM. For the period “beyond 2011” a road map is suggested that will have uniformity of assessment of VP–PM and a focusing on the important goals of VP–PM. (J Am Coll Cardiol 2012;60:1123–35) © 2012 by the American College of Cardiology Foundation Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.05.035